title: Laparoscopic repair of hiatal hernia after esophagectomy.
abstract: BACKGROUND
  Herniation of abdominal contents via the diaphragmatic hiatus is a potentially life-threatening complication of esophagectomy. Mounting evidence suggests that hiatal hernias are more common following minimally invasive esophagectomy. Therefore, post-esophagectomy hiatal hernia and its treatment bear increasing significance.
  
  
  METHODS
  We retrospectively reviewed the records of five patients with hiatal hernia following esophagectomy over a 5-year period.
  
  
  RESULTS
  Successful laparoscopic reduction of a post-esophagectomy hiatal hernia was done without mesh reinforcement in three patients. One patient underwent mesh reinforcement. One patient was found to have carcinomatosis upon laparoscopic inspection, and repair of the hiatal hernia was abandoned. There were no perioperative deaths or complications. One patient developed a recurrent hiatal hernia 14 months after repair of the initial hiatal hernia. Patients were discharged within a mean of 1.75 days after surgical repair.
  
  
  CONCLUSIONS
  We have successfully used laparoscopy to treat hiatal hernias after esophagectomy. The benefits conferred by laparoscopy, including better visualization of the right gastroepiploic artery supplying the gastric conduit, minimally invasive evaluation of the field for metastasis, and shorter recovery time, make it our favored approach. Here, we describe our experience with hiatal hernia following esophagectomy and our operative technique.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. cherie.p.erkmen@hitchcock.org
authors.forename: Cherie P
authors.initials: CP
authors.lastname: Erkmen
authors.forename: Vignesh
authors.initials: V
authors.lastname: Raman
authors.forename: Neil D
authors.initials: ND
authors.lastname: Ghushe
authors.forename: Thadeus L
authors.initials: TL
authors.lastname: Trus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006551:Hernia, Hiatal / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh